Acute stroke and TIA management Flashcards
(33 cards)
what are the 7 Rs of acute stroke management
Recognise; React (transfer to stroke unit); Respond (imaging etc.); Reveal (confirm diagnosis); Reperfusion (thrombolysis etc.); Rehabilitation (stoke team assessment); Reintegration
what are two pre-hospital screening tests that can be deployed
FAST and MASS
what is the immediate treatment for TIAs in order to reduce the risk of stroke
Aspirin 300mg (or clopidogrel if contraindicated), then 75mg daily; specialist assessment within 24hrs of onset; secondary prevention when confirmed diagnosis e.g. statin; carotid duplex scan (if in anterior circulation)
what is the treatment for TIAs with symptoms >1week prior
specialist assessment ASAP; MRI (T2) to exclude haemorrhage; immediate initiation of clopidogrel; secondary prevention when confirmed diagnosis
what is a carotid enterectomy
a surgery to remove plaques from the carotid arteries
what are indication for immediate brain imaging in acute stroke (7)
indication for thrombolysis/early anticoagulation; been taking anticoags; known bleeding tendency; decreased level of consciousness (GSC<3); unexplained progressive/fluctuating symptoms; papilloedema/neck stiffness/ fever; severe headache at onset
what will early CT scanning show?
ischemic: may be normal or only show subtle change, ischemia not seen until at least a few hours later; haemorrhagic: haemorrhage will almost always been seen even early on
what score can be used to check early imaging for ischemic stroke?
ASPECT score
what is thrombolysis
the activation of plasminogen to breakdown a clot
what is plasminogen converted into during thrombolysis
plasmin
what drug is currently used for thrombolysis
Alteplase
what is the ischaemic penumbra
an area of moderate ischemia, infarction has been delayed here; this area of tissue may be saved
what is the risk associated with thrombolysis
1-2% of people may haemorrhage which may result in death
indications for thrombolysis (4)
definite weakness/dysphagia regardless of severity; symptom onset >30mins but <4.5hrs; 18+ yro; GCS <8
absolute contraindications of thrombolysis (9)
Hx of ICH; CT shows hypodensity; INR>= 1.7 and aPPT >35 or on NOACs; platelets <100x10^9; sensory symptoms only; seizure with neurologic impairment; possible SAH; BP> 185/110 (with treatment); rapidly resolving symptoms
what is INR?
international normalized ratio - prothrombin time
what is aPPT?
Shortened Activated Partial Thromboplastin Time
relative contraindications of thrombolysis (8)
time since onset of symptoms >4.5-6hrs; bacterial endocarditis/pericarditis; treated with LMWH within 48hts; previous stroke/head injury in the past 3 months; serious GI/Urinary bleed in the past 21 days; surgery/significant trauma in past 14days; severe liver disease/possibility of pregnancy; severe pre-stroke morbidity
what is a thrombectomy
a surgery performed to remove a clot from a blood vessel
how should acute stroke patients be treated (excluding ICHs)
aspirin (300mg loading dose) for 2 weeks then clopidogrel; PPI for those over 70+ alongside; if already on aspirin then can use dual anti-platelet agent (for a month); anti-coag has no routine role for ischemic stroke
what is DVT/PE prophylaxis post stroke
LMWH (if ICH excluded, previous VTE or mobility restricted); Intermittent Pneumatic Compression stockings (within 3 days of event); if ischemic stroke and symptomatic for DVT then anti-coag; if haemorrhagic and symptomatic for DVT then vena caval filter
what other treatments can be considered for MCA infarct?
decompressive craniotomy - if referred within 24hrs and treatment is given within 48hrs; CT shows >50% of MCA occluded by infarct
how is a carotid/vertebral dissection treated?
thrombolysis, long-term anticoagulants/ anti-platelets
how can a carotid dissection occur?
twisting, turning e.g. during extreme sport
